Imputation method to reduce undetected severe acute respiratory infection cases during the coronavirus disease outbreak in Brazil

Oliveira, Silvano Barbosa de; Ganem, Fabiana; Araújo, Wildo Navegantes de; Casabona, Jordi; Sanchez, Mauro Niskier; Croda, Julio

doi:10.1590/0037-8682-0528-2020

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Revista da Sociedade Brasileira de Medicina Tropical

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Short Communication • Rev. Soc. Bras. Med. Trop. 53 • 2020 • https://doi.org/10.1590/0037-8682-0528-2020 copy

Imputation method to reduce undetected severe acute respiratory infection cases during the coronavirus disease outbreak in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

The coronavirus disease (COVD-19) outbreak has overburdened the surveillance of severe acute respiratory infections (SARIs), including the laboratory network. This study was aimed at correcting the absence of laboratory results of reported SARI deaths.

METHODS:

The imputation method was applied for SARI deaths without laboratory information using clinico-epidemiological characteristics.

RESULTS:

Of 84,449 SARI deaths, 51% were confirmed with COVID-19 while 3% with other viral respiratory diseases. After the imputation method, 95% of deaths were reclassified as COVID-19 while 5% as other viral respiratory diseases.

CONCLUSIONS:

The imputation method was a useful and robust solution (sensitivity and positive predictive value of 98%) for missing values through clinical & epidemiological characteristics.

Keywords:
COVID-19; SARI; Laboratory test; Signs and symptoms; Imputation method

UF	Total	COVID-19		Other viral respiratory diseases		Missing*
	nº	nº	%	nº	%	nº	%
Brazil	84449	42981	51	2340	3	39128	46
AC	203	184	91	4	2	15	7
AL	1234	618	50	55	4	561	45
AM	4144	1829	44	80	2	2235	54
AP	191	94	49	0	0	97	51
BA	2824	1472	52	176	6	1176	42
CE	7579	3683	49	302	4	3594	47
DF	902	486	54	17	2	399	44
ES	1321	880	67	70	5	371	28
GO	940	401	43	34	4	505	54
MA	2530	944	37	308	12	1278	51
MG	3133	688	22	75	2	2370	76
MS	345	66	19	19	6	260	75
MT	311	99	32	29	9	183	59
PA	5825	3124	54	199	3	2502	43
PB	1470	557	38	93	6	820	56
PE	5243	3834	73	65	1	1344	26
PI	665	346	52	33	5	286	43
PR	2169	530	24	59	3	1580	73
RJ	13019	7514	58	225	2	5280	41
RN	1005	509	51	36	4	460	46
RO	247	135	55	13	5	99	40
RR	337	134	40	3	1	200	59
RS	2009	530	26	6	0	1473	73
SC	811	243	30	12	1	556	69
SE	302	168	56	18	6	116	38
SP	25411	13754	54	406	2	11251	44
TO	265	151	57	3	1	111	42

Variables	Total	COVID-19		Univariate	Multivariate
	nº	nº	%	OR (95% CI)	OR (95% CI)
Total	45321	42981	94.8	-	-
Sex
Male	26378	24993	94.7	1.00	-
Female	18929	17977	95.0	1.05 (0.96-1.14)	-
Missing	14	11	78.6	-	-
Age group
<10 years	224	161	71.9	1.00	1.00
10 to 39 years	2318	2141	92.4	4.73 (3.41-6.58)	5.72 (3.08-10.39)
40 to 59 years	9708	9208	94.8	7.21 (5.31-9.78)	7.71 (4.32-13.34)
60 to 69 years	10341	9826	95.0	7.47 (5.51-10.12)	8.51 (4.76-14.77)
>70 years	22730	21645	95.2	7.81 (5.80-10.51)	8.14 (4.60-13.94)
Signs and symptoms
Respiratory distress	28634	26942	94.1	0.69 (0.61-0.78)	0.77 (0.65-0.92)
Fever	29889	28251	94.5	0.82 (0.73-0.92)	-
Cough	31431	29765	94.7	0.87 (0.77-0.99)	-
Throat pain	7362	6908	93.8	0.80 (0.72-0.90)	-
Dyspnea	34513	32618	94.5	0.86 (0.75-0.98)	-
O₂ saturation <95%	29416	27821	94.6	0.95 (0.85-1.07)	-
Diarrhea	4688	4453	95.0	1.03 (0.89-1.19)	-
Vomit	2770	2606	94.1	0.86 (0.72-1.01)	-
Comorbidities
Chronic cardiovascular disease	17682	16926	95.7	1.25 (1.10-1.41)	1.10 (0.95-1.28)
Diabetes mellitus	14037	13397	95.4	1.15 (1.02-1.30)	1.20 (1.04-1.40)
Chronic hematological disease	521	496	95.2	1.04 (0.69-1.56)	-
Chronic liver disease	590	567	96.1	1.29 (0.84-1.97)	-
Asthma	935	880	94.1	0.83 (0.62-1.10)	-
Chronic neurological disease	2698	2572	95.3	1.05 (0.86-1.27)	-
Other chronic pneumopathy	2384	2267	95.1	1.02 (0.84-1.25)	-
Immunodeficiency/immunodepression	1744	1662	95.3	1.05 (0.83-1.33)	-
Chronic kidney disease	2926	2811	96.1	1.30 (1.06-1.59)	-
Obesity	1700	1639	96.4	1.45 (1.11-1.89)	-
Hospitalization
No	2168	2065	95.2	1.00	-
Yes	40429	38466	95.1	0.98 (0.80-1.20)	-
Missing	4892	4515	92.3	-	-
Intensive care unit stay
No	14289	13525	94.7	1.00	-
Yes	20426	19464	95.3	1.14 (1.04-1.26)	-
Missing	24895	23517	94.5	-	-
Ventilation support
No	5131	4839	94.3	1.00	1.00
Yes, invasive	16944	16061	94.8	1.10 (0.96-1.26)	1.32 (1.08-1.61)
Yes, non-invasive	12065	11516	95.4	1.27 (1.09-1.47)	1.38 (1.11-1.70)

UF	Total	COVID-19		Other viral respiratory
UF	nº	nº	%	nº	%
Brazil	84449	80022	95	4427	5
AC	203	198	98	5	2
AL	1234	1134	92	100	8
AM	4144	3956	95	188	5
AP	191	187	98	4	2
BA	2824	2579	91	245	9
CE	7579	7082	93	497	7
DF	902	869	96	33	4
ES	1321	1233	93	88	7
GO	940	878	93	62	7
MA	2530	2147	85	383	15
MG	3133	2944	94	189	6
MS	345	307	89	38	11
MT	311	267	86	44	14
PA	5825	5494	94	331	6
PB	1470	1334	91	136	9
PE	5243	5103	97	140	3
PI	665	614	92	51	8
PR	2169	2022	93	147	7
RJ	13019	12512	96	507	4
RN	1005	948	94	57	6
RO	247	231	94	16	6
RR	337	326	97	11	3
RS	2009	1924	96	85	4
SC	811	770	95	41	5
SE	302	281	93	21	7
SP	25411	24409	96	1002	4
TO	265	260	98	5	2

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[1] Corresponding author: Dr. Julio Croda. e-mail:juliocroda@gmail.com